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2.
Medicine (Baltimore) ; 101(48): e32052, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36482620

RESUMO

BACKGROUND: The goal of this study was to see if using mirabegron, solifenacin, or placebo may help patients with transurethral resection avoid catheter-related bladder discomfort (CRBD). METHODS: Patients who underwent transurethral surgery and were given a catheter for 3 days after surgery were chosen for this study. The enrolled patients were separated into 3 groups: mirabegron (M), solifenacin (S), and a blank control group (C). All patients had their overactive bladder symptoms score (OABSS) and blood pressure checked before surgery. The CRBD, blood pressure, and heart rate were measured at 6, 24, 48, and 72 hours after surgery. The OABSS and side effects were documented on the 7th day. RESULTS: The 104 patients in this trial were randomized into 3 groups at random: M, S, and C. The ultimate follow-up was completed by 99 patients, including 33 in group M, 33 in group S, and 33 in group C. The OABSS, CRBD, and blood pressure in groups M and S were similar before and after surgery (P > .05). Groups M and S performed much better on the OABSS and CRBD than group C (P < .05). There were no significant differences in blood pressure between the 3 groups (P > .05). There were no significant differences in the occurrences of new onset dry mouth (P = .84) or constipation (P = .64) among the 3 groups. CONCLUSION: Mirabegron is comparable to solifenacin as an alternative for the prevention of CRBD, making it a viable option for CRBD prevention.


Assuntos
Succinato de Solifenacina , Bexiga Urinária , Humanos , Estudos de Casos e Controles , Succinato de Solifenacina/uso terapêutico
3.
Sci Rep ; 12(1): 18844, 2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36344629

RESUMO

To observe the efficacy and safety of solifenacin and/or mirabegron as a medical expulsive therapy (MET) in patients with double-J stent-related overactive bladder (OAB) symptoms. A total of 219 patients with double-J stent-related OAB symptoms were prospectively randomized into two groups. One-hundred and nine cases in the combination group accepted mirabegron and solifenacin therapy and 110 cases as control only accepted solifenacin therapy. The lower urinary tract symptoms and overactive bladder questionnaire (OAB-q) health-related quality of life (HRQol) and symptom bother score between two groups were compared at the 1st, 2nd and 4th week ends. All of 219 patients were randomly assigned to two groups, of which 109 patients were included in the combination group and 110 in the solifenacin group. The incidences of LUTS, including urgency, frequent urination, and incontinence episodes, in the 2nd week (44.9% vs. 64.5%, P = 0.028; 48.6% vs. 62.7%, P = 0.036; and 40.4% vs. 56.4%, P = 0.018) and the 4th week (14.7% vs. 30.9%, P = 0.004; 16.5% vs. 33.6%, P = 0.003; and 11.9% vs. 26.4%, P = 0.007) after combination treatment were significantly lower than those in the solifenacin group. The incidence of drug-related adverse events in the solifenacin group was higher than that in the combination group, but there was no statistically significant difference (P > 0.05). In terms of secondary variables, the OAB-q HRQol score in the combination group was statistically superior in comparison with that in the solifenacin group between the second and fourth week (77.9 vs. 76.4, P = 0.020; and 87.9 vs. 85.6, P = 0.001). The OAB-q symptom bother score was higher in the solifenacin group than in the combination group (37.6 vs. 36.4, P = 0.016; and 26.2 vs. 24.8, P = 0.003). Combination therapy of solifenacin and mirabegron demonstrated significant improvements over solifenacin monotherapy in reducing OAB symptoms associated with double-J stents, and providing a higher quality of life without increasing bothersome adverse effects.


Assuntos
Succinato de Solifenacina , Bexiga Urinária Hiperativa , Humanos , Succinato de Solifenacina/efeitos adversos , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/diagnóstico , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Quimioterapia Combinada , Acetanilidas/efeitos adversos , Stents , Antagonistas Muscarínicos/uso terapêutico
4.
Sci Rep ; 12(1): 17905, 2022 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-36289427

RESUMO

To summarize the differences in urodynamic outcomes between oral antimuscarinic drugs and OnabotulinumtoxinA, and finding a therapy that maintains good urodynamics in neurogenic detrusor overactivity (NDO). We conducted a literature search of EMBASE and PubMed, with the language limited to English. In the analysis, all of the published randomized trials of OnabotulinumtoxinA or antimuscarinic drugs used to treat NDO were found and the results were finally obtained through Bayesian model analysis. A total of 12 RCTs and 2208 patients were included. OnabotulinumtoxinA 300U was superior to other drugs in terms of MCC, volume at IDC, and Pdetmax endpoints. OnabotulinumtoxinA 200U was more effective on the urodynamic endpoint of BC than other drugs or doses of OnabotulinumtoxinA. According to the MCC urodynamic results, oxybutynin, solifenacin 10 mg, and tolterodine 4 mg also had positive effects. OnabotulinumtoxinA 300U, 200U and 100U were better in improving the urodynamic results of NDO, and the current evidence also shows that selective injection of onabotulinumtoxinA can effectively improve the urodynamic results.


Assuntos
Toxinas Botulínicas Tipo A , Bexiga Urinaria Neurogênica , Bexiga Urinária Hiperativa , Humanos , Urodinâmica , Antagonistas Muscarínicos/uso terapêutico , Antagonistas Muscarínicos/farmacologia , Bexiga Urinaria Neurogênica/tratamento farmacológico , Succinato de Solifenacina/farmacologia , Succinato de Solifenacina/uso terapêutico , Metanálise em Rede , Tartarato de Tolterodina/farmacologia , Teorema de Bayes , Resultado do Tratamento , Bexiga Urinária Hiperativa/tratamento farmacológico
7.
Sci Rep ; 12(1): 14219, 2022 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-35987885

RESUMO

The study aims to elucidate the impact of mirabegron versus solifenacin on autonomic function and peripheral arterial conditions in women with overactive bladder syndrome (OAB). All consecutive women with OAB were randomized to receive 12 weeks of mirabegron 25 mg or solifenacin 5 mg once per day. Heart rate variability, cardio-ankle vascular index, ankle-brachial pressure index, blood pressure, and heart rate were compared between the two groups. There were 87 women (mirabegron, n = 43; and solifenacin, n = 44) who completed 12-week treatment and underwent heart rate variability examination. Systolic blood pressure (median: - 4.5 to - 5.5 mmHg) and diastolic blood pressure (median: - 0.5 to - 3.5 mmHg) decreased after solifenacin treatment, and heart rate (median: + 2 bpm) increased after mirabegron treatment, despite of no between-group difference. In addition, posttreatment heart rate variability, cardio-ankle vascular index, and ankle-brachial pressure index did not differ compared with baseline; and there were no between-group differences. In conclusion, solifenacin might decrease blood pressure, and mirabegron might increase heart rate. Nonetheless, there were no significant impacts of 12-week mirabegron versus solifenacin treatment on autonomic function and arterial stiffness.


Assuntos
Bexiga Urinária Hiperativa , Agentes Urológicos , Rigidez Vascular , Acetanilidas/farmacologia , Acetanilidas/uso terapêutico , Feminino , Humanos , Antagonistas Muscarínicos , Succinato de Solifenacina/uso terapêutico , Tiazóis , Resultado do Tratamento , Bexiga Urinária Hiperativa/tratamento farmacológico , Agentes Urológicos/farmacologia , Agentes Urológicos/uso terapêutico
8.
Sci Rep ; 12(1): 12365, 2022 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-35858980

RESUMO

Evidence to support the effectiveness of ß3-adrenoceptor agonist mirabegron and anti-muscarinic solifenacin in the management of bladder dysfunction caused by psychological stress is lacking. This study investigates whether mirabegron or solifenacin reduces the bladder overactivity caused by water avoidance stress (WAS) in mice. Female mice were exposed to WAS for 1 h/day for 10 days and received either placebo, solifenacin or mirabegron in drinking water. Controls were age-matched without stress exposure. Voiding behaviour and functional isolated whole bladder responses during distension and in response to pharmacological agents and electrical field stimulation was investigated. Urinary frequency was significantly increased following stress. Mice treated with mirabegron or solifenacin displayed significantly fewer voiding events compared to the stressed mice, and voiding frequency in drug-treated animals was comparable to unstressed controls. The maximal contractile responses of bladders to carbachol were significantly enhanced by stress and reduced by mirabegron but not solifenacin. The frequency of phasic bladder contractions following stimulation with carbachol was significantly enhanced following stress and remained elevated in the mirabegron treated group. However, treatment with solifenacin significantly reduced the frequency of phasic contractions to unstressed control levels. Solifenacin and mirabegron are beneficial in reducing the overall voiding dysfunction caused by WAS in mice.


Assuntos
Succinato de Solifenacina , Bexiga Urinária Hiperativa , Acetanilidas/farmacologia , Animais , Carbacol , Feminino , Camundongos , Antagonistas Muscarínicos/uso terapêutico , Succinato de Solifenacina/farmacologia , Succinato de Solifenacina/uso terapêutico , Estresse Psicológico , Tiazóis , Resultado do Tratamento
9.
In Vivo ; 36(4): 1847-1853, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35738641

RESUMO

BACKGROUND/AIM: In clinical practice, constipation is one of the most frequent adverse events caused by drugs for overactive bladder (OAB). The occurrence of constipation greatly deteriorates the patient's quality of life. The aim of the study was to evaluate and compare the effects of three commonly used ß3 agonists and anticholinergic drugs on the defecation status in patients with OAB. PATIENTS AND METHODS: We retrospectively reviewed the defecation status in patients who received mirabegron, solifenacin, or fesoterodine for OAB. We evaluated changes in the (a) urological parameters using the OAB symptom score (OABSS) and (b) defecation status using the Bristol Stool Form Scale (BSFS) and constipation scoring system (CSS) following 12 weeks of drug administration. RESULTS: We analyzed data from 165 patients (mirabegron=56, fesoterodine=52, and solifenacin=57). The solifenacin group showed a significant decrease in BSFS (from 3.2±1.0 at baseline to 2.3±12 post-treatment) and an increase in hardened stools (p<0.001). Elimination worsened as assessed by almost all items, and the total modified CSS scores worsened significantly from 4.8±2.6 points at baseline to 8.O±4.8 points after 12 weeks of solifenacin treatment (p<0.001). The mirabegron group showed no changes in any of the CSS items. In the fesoterodine group, the CSS scores for "completeness" and "assistance" increased significantly after treatment (p<0.001 and p=0.013, respectively). CONCLUSION: All three drugs were effective for OAB. Mirabegron had almost no effect on constipation; fesoterodine, an anticholinergic drug, also had hardly any effect on defecation.


Assuntos
Bexiga Urinária Hiperativa , Agentes Urológicos , Antagonistas Colinérgicos/efeitos adversos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/tratamento farmacológico , Defecação , Humanos , Qualidade de Vida , Estudos Retrospectivos , Succinato de Solifenacina/efeitos adversos , Resultado do Tratamento , Bexiga Urinária Hiperativa/induzido quimicamente , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/epidemiologia , Agentes Urológicos/efeitos adversos
10.
Am J Ther ; 29(5): e507-e511, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35731251

RESUMO

BACKGROUND: Neurogenic detrusor overactivity (NDO) is treated with antimuscarinics as first-line treatment. For patients with contraindications or unresponsive, intradetrusor injections with botulinum toxin (BoNT) are a safe and effective but expensive option. STUDY QUESTION: Our study evaluated whether adding solifenacin to the intradetrusor injection of BoNT A could boost the effect of BoNT in patients with NDO due to multiple sclerosis or spinal cord injury refractory to antimuscarinics alone and/or lead to less frequent injections. STUDY DESIGN: We performed a prospective study on 49 patients assigned alternatively to group A, undergoing BoNT injections, and group B, adding solifenacin. MEASURES AND OUTCOMES: We gathered data from urodynamic testing and questionnaire assessments before and 3 months after injections and reinjections. We analyzed 39 patients who achieved total continence and a minimum 24-month follow-up period. RESULTS: After treatment, both groups had statistically significant improvement of overactive bladder questionnaire (OABq) score, post void residue (PVR), and peak detrusor pressure (Pdet). Reinjection was needed after a mean 8.2 months for group A and 11.7 months for group B. We analyzed the improvement rate of parameters compared between the 2 groups-group B had greater OABq score improvement (A = 17.25 ± 5.07, B = 20.44 ± 4.51, P = 0.0485), as well as for maximum bladder capacity (A = 11.05 ± 7.04 mL, B = 19.39 ± 6.43 mL, P = 0.0005); differences in Pdet change (A = 51.72 ± 16.57 cmH 2 O, B = 50.80 ± 16.33 cmH 2 O, P = 0.7635) and PVR change (A = 17.67 ± 12.63 mL, B = 12.30 ± 8.32 mL, P = 0.126) were not statistically significant. CONCLUSIONS: Our study shows that adding solifenacin improves patient satisfaction, increases the interval between reinjections, thus lowering costs, and improves maximum bladder capacity. Pdet was kept in safe ranges, but no statistically significant conclusions could be drawn regarding Pdet and PVR decrease related to adding solifenacin. Although our study is limited by the small series of patients and lack of randomization and placebo control group, the BoNT-solifenacin combination could be considered in NDO in terms of cost-effectiveness. Further studies would be beneficial.


Assuntos
Toxinas Botulínicas Tipo A , Bexiga Urinaria Neurogênica , Bexiga Urinária Hiperativa , Toxinas Botulínicas Tipo A/efeitos adversos , Humanos , Antagonistas Muscarínicos/uso terapêutico , Estudos Prospectivos , Succinato de Solifenacina , Resultado do Tratamento , Bexiga Urinaria Neurogênica/induzido quimicamente , Bexiga Urinaria Neurogênica/tratamento farmacológico , Bexiga Urinária Hiperativa/tratamento farmacológico
11.
J Urol ; 208(4): 863-871, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35686842

RESUMO

PURPOSE: We analyzed the relationship between use of anticholinergic drugs to treat overactive bladder (OAB) and risk of incident dementia in older patients, overall and for each drug separately. MATERIALS AND METHODS: We conducted a nested case-control study using the French National Medical-Administrative Database. We identified incident dementia cases and controls from January 1, 2013 to December 31, 2018 in individuals aged ≥60 years. Controls were matched 5:1 to cases by date of case diagnosis (index date), age, sex, and income. We set a 5-year exposure period ending 2 years before the index date (lag-time period to avoid protopathic bias). We quantified cumulative exposure to flavoxate, oxybutynin, solifenacin, trospium, and fesoterodine using defined daily doses (DDDs). We performed conditional logistic regression analyses adjusted for factors known to be associated with OAB and/or dementia including obesity, diabetes, stroke, coronary heart disease, and psychotic disorders. RESULTS: We analyzed 4,810 cases and 24,050 matched controls with a median age of 82 years. OAB anticholinergic use was associated with an increased risk of dementia (adjusted OR [aOR]=1.23, 95% CI 1.10-1.37) with a cumulative dose-response: aOR=1.07 (95% CI 0.91-1.25) for 1-90 DDDs, aOR=1.29 (1.05-1.58) for 91-365 DDDs and aOR=1.48 (1.22-1.80) for >365 DDDs. Considering each OAB anticholinergic separately showed a particularly marked increased risk of dementia for oxybutynin and solifenacin, but no increased risk for trospium. CONCLUSIONS: When treating OAB in older patients, OAB anticholinergics should be used with caution, taking into account the patient's cognitive status, the anticholinergic load, and the different therapeutic options.


Assuntos
Demência , Bexiga Urinária Hiperativa , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Antagonistas Colinérgicos/efeitos adversos , Demência/induzido quimicamente , Demência/epidemiologia , Humanos , Antagonistas Muscarínicos/uso terapêutico , Succinato de Solifenacina/uso terapêutico , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/epidemiologia
12.
World J Urol ; 40(8): 2113-2119, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35760910

RESUMO

PURPOSE: We aimed to assess the efficacy and safety of Mirabegron vs. solifenacin to treat LUTS resulting from DJ-stent insertion. METHODS: A total of 97 patients who had DJ-stent inserted for urinary stone disease were randomly divided into three groups according to received treatment. Group A took Mirabegron 50 mg daily, group B took solifenacin 5 mg daily from the 4th day after stent placement until the stent was removed, and group C only was hydrated well. All patients were evaluated by USSQ and IPSS at 4th day post-insertion of ureteral stent, follow-up day before removing of stent and post-removal of stent. RESULTS: The USSQ urinary symptom scores at day 4 comparing to day of removal of stent showed significant difference in between study groups (32 ± 6-13 ± 6 vs. 31 ± 6-14 ± 4 in Mirabegron and solifenacin, respectively) and without significant difference in control group. The USSQ body pain score significantly decreased in both Mirabegron and solifenacin groups at day of stent removal comparing to day 4 post-insertion of DJ with insignificant decreasing in the control group. Quality of life scores showed significant improving in Mirabegron and solifenacin group, and there was no difference in control group at 4 and 14 days after treatment. No severe complications were observed in either group. DISCUSSION/CONCLUSION: In our series, we indicate that Mirabegron and solifenacin can be used to improve symptoms caused by the insertion of DJ-stent without significant difference.


Assuntos
Succinato de Solifenacina , Agentes Urológicos , Acetanilidas/uso terapêutico , Humanos , Qualidade de Vida , Succinato de Solifenacina/uso terapêutico , Stents , Tiazóis , Resultado do Tratamento , Agentes Urológicos/uso terapêutico
13.
Pharmacoepidemiol Drug Saf ; 31(8): 883-891, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35587029

RESUMO

BACKGROUND: Older adults are at an increased risk of delirium because of age, polypharmacy, multiple comorbidities and acute illness. Antimuscarinics are the backbone of the pharmacological management of overactive bladder. However, the safety profiles of antimuscarinics vary because of their dissimilarities to muscarinic receptor-subtype affinities and are associated with differential central anticholinergic adverse effects. OBJECTIVE: This study aimed to examine delirium risk in new users of oxybutynin and solifenacin in older adults (≥ 65 years). In the secondary analyses, we examined the risk of delirium by type and dose of antimuscarinic. METHOD: We applied a case-time-control design to investigate delirium risk in older adults who started taking oxybutynin and solifenacin. We used a nationwide inpatient hospital data (2005-2016), National Minimum Data Set, maintained by the Ministry of Health, New Zealand (NZ), to identify older adults with a new-onset diagnosis of delirium. Eligible patients were older adults aged 65 at entry into the cohort on 1/1/2006. We used dispensing claims data to determine antimuscarinic treatment exposure. The antimuscarinic included in the study were new users of oxybutynin and solifenacin. These two antimuscarinics are subsidised by the Pharmaceutical Management Agency and are the most frequently used antimuscarinic in NZ. A conditional logistic regression model was used to compute matched odds ratios (MORs) and 95% confidence intervals (CIs). In the case-time-control design, we made separate analyses to evaluate the dose-response risk of delirium. RESULTS: We identified 4818 individuals (mean age 82.14) from 2005 to 2015 with incident delirium and were exposed to at least one of the antimuscarinic of interest. The case-time-control matched odds ratio (MOR) for delirium with oxybutynin was (2.06, 95% confidence interval [CI] 1.07-3.96). Solifenacin was not associated with delirium (0.89 95%CI 0.64-1.23). In the sensitivity analyses, the case-time-control MOR for delirium using a shorter risk period (0-3 days) did not change the results. The dose-response risk of delirium was significant for oxybutynin (0.05, 95%CI 0.02-0.08) but not for solifenacin (-0.01, 95%CI -0.03 to 0.00). In addition, in the subgroup analyses, a statistically significant association of delirium was found for oxybutynin but not for solifenacin in the non-dementia cohort (2.11,95% CI 1.08-4.13) and the dementia cohort (1.25, 95%CI 0.05-26.9). CONCLUSION: The study found that oxybutynin but not solifenacin is associated with a risk of new-onset delirium in older adults. The higher blockade of M1 and M2 receptors by oxybutynin is likely to contribute to delirium than solifenacin, which is highly selective for the M3 receptor subtype. Therefore, the treatment choice with an M3 selective agent must be given due consideration, particularly in those with pre-existing cognitive impairment.


Assuntos
Delírio , Bexiga Urinária Hiperativa , Idoso , Idoso de 80 Anos ou mais , Antagonistas Colinérgicos , Delírio/induzido quimicamente , Delírio/tratamento farmacológico , Delírio/epidemiologia , Humanos , Antagonistas Muscarínicos/efeitos adversos , Succinato de Solifenacina/efeitos adversos , Bexiga Urinária Hiperativa/induzido quimicamente
14.
Front Public Health ; 10: 827853, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35372235

RESUMO

Background: Mixed urinary incontinence increasingly undermines women's quality of life. Previous studies showed some effects of acupuncture for MUI, but no systematic review has been done to evaluate the efficacy and safety of acupuncture for MUI in women. Objective: To systematically review the efficacy and safety of acupuncture for women with MUI. Methods: Ten databases (i.e., PubMed, Web of Science, Embase, ClinicalTrials.gov, the Cochrane Library, CBM, Scoups, CNKI, VIP and WANFANG DATA) were searched up to July 19th, 2021, using tailored search strategies with keywords not limited to "female," "mixed urinary incontinence," "acupuncture," and "randomized controlled trial," etc. RCTs and quasi-RCTs were included if investigating effect of any type of acupuncture for female patients with MUI. Data were extracted from eligible studies, and risks of bias were assessed according to the Cochrane Handbook from seven aspects using the RevMan 5.4 software. Results: A total of three randomized studies with 591 women were included. The risk of bias among the studies varied, with major concerns on blinding of participants and outcome assessor. Liu's study (497) mainly showed that electroacupuncture's effect on reduction of numbers of incontinence, urgency, nocturia episodes, and amount of urine leakage etc. was not inferior to that of PFMT-Solifenacin group at 12, 24, and 36 weeks. Zhan's study (60) showed that electroacupuncture reduced significantly more amount of urine leakage than Tolterodine at 8 weeks, with no data on incontinence episodes frequency. All 3 studies reported that acupuncture significantly increased the quality of life assessed by ICIQ score. In addition, incidence of acupuncture-related adverse events was rare, while antimuscarinic agents related adverse events were common in two studies. Conclusion: Although acupuncture showed some benefit for women with MUI, more evidences were required to draw a solid conclusion of effectiveness and safety of acupuncture for women with MUI. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021224600.


Assuntos
Terapia por Acupuntura , Incontinência Urinária , Feminino , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Succinato de Solifenacina , Incontinência Urinária/terapia
15.
J Formos Med Assoc ; 121(10): 2101-2108, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35450742

RESUMO

PURPOSE: This cohort study evaluates therapeutic efficacy and adverse events (AEs) of various overactive bladder (OAB) medications for patients with central nervous system (CNS) disorders. METHODS: Patients with OAB and CNS disorders were prospectively enrolled. They were randomly allocated to 3 different treatment subgroups: (1) mirabegron 50 mg once daily (2) solifenacin 5 mg per day, and (3) combined solifenacin 5 mg and mirabegron 50 mg once daily. Efficacy and safety questionnaires and objective parameters were compared among the subgroups, and subgroups between baseline and 3 and 6 months after treatment. AEs, including cognitive dysfunction, were assessed using the Mini-Mental State Examination (MMSE). RESULTS: 102 patients (mean age, 71.8 ± 8.7 years) were enrolled, including 35, 36, and 31 patients received mirabegron monotherapy, solifenacin monotherapy, and combination therapy, respectively. OAB symptoms scores all significantly improved 3 months after treatment in different subgroup. However, PVR increased and VE decreased significantly after treatment in patients receiving solifenacin monotherapy and combination therapy. Dry mouth and constipation were the most common AEs, especially in the solifenacin and combination subgroups. Mild incidence of AEs was noted in patients receiving mirabegron monotherapy. No significant change in MMSE was noted among the subgroups after treatment. CONCLUSION: OAB medication had good therapeutic efficacy in patients who had OAB with CNS disorders, especially in cerebrovascular accident and parkinsonism. No OAB medication or their combination affected cognitive function, whereas minimal AEs were noted with mirabegron. Mirabegron could be recommended as the first choice for managing OAB in these patients.


Assuntos
Doenças do Sistema Nervoso Central , Bexiga Urinária Hiperativa , Agentes Urológicos , Acetanilidas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/tratamento farmacológico , Cognição , Estudos de Coortes , Quimioterapia Combinada/efeitos adversos , Humanos , Pessoa de Meia-Idade , Succinato de Solifenacina/efeitos adversos , Tiazóis/efeitos adversos , Resultado do Tratamento , Bexiga Urinária Hiperativa/tratamento farmacológico , Agentes Urológicos/efeitos adversos
17.
Female Pelvic Med Reconstr Surg ; 28(3): e49-e54, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35272333

RESUMO

IMPORTANCE: Antimuscarinic medications are often discontinued, and there is a paucity of data regarding patient experience of medications within this class. OBJECTIVE: The objective of this study is to qualitatively explore patient experience of antimuscarinic medications used for overactive bladder using reviews on Drugs.com. STUDY DESIGN: We examined reviews prior to February 2, 2020 (available since 2008) for oral antimuscarinic medications. User content was reviewed qualitatively via inductive content analysis. Investigators coded third-party impressions, categorizing each review as positive, mostly positive, mostly negative, or negative. The prevalence of side effects, themes, and impressions are described, with comparisons by drug using χ2, Mann-Whitney U, and Kruskal-Wallis tests, as appropriate. Correlation between ordinal and categorical variables was performed using Tau and Spearman correlation coefficients, respectively. RESULTS: We analyzed 469 user reviews. 68.2% reported symptom improvement. The most common side effects were dry mouth (29%) and fatigue (10.7%). Fewer neurologic side effects were reported in the solifenacin (13.9%) and trospium (none) groups (P = 0.009). Tolterodine and trospium immediate release had lower rates of ears, nose, and throat side effects (22.5% and 26.2%, respectively, P = 0.001.) Analysis of themes suggested 2 domains driving overall satisfaction: improvement and side effects. Improvement was associated with a positive satisfaction score (ρ = 0.64, P < 0.001) and gestalt impression (ρ = 0.74, P < 0.001). The factors that most negatively affected these measures were persistent symptoms followed by gastrointestinal side effects (P < 0.001). CONCLUSIONS: Our data suggest important differences within this class of medication both in terms of side effects and patient satisfaction. Furthermore, symptom improvement is the leading factor for patient satisfaction, whereas gastrointestinal side effects are associated with dissatisfaction.


Assuntos
Antagonistas Muscarínicos , Bexiga Urinária Hiperativa , Feminino , Humanos , Masculino , Antagonistas Muscarínicos/efeitos adversos , Avaliação de Resultados da Assistência ao Paciente , Succinato de Solifenacina/efeitos adversos , Tartarato de Tolterodina , Bexiga Urinária Hiperativa/tratamento farmacológico
18.
Braz J Med Biol Res ; 55: e11721, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35320336

RESUMO

The use of bladder antimuscarinics is very common in the elderly. However, recent population-based studies that assessed the use of anticholinergics or bladder antimuscarinics showed an increased risk of dementia when these drugs were used for a prolonged period. Several of these population-based studies included patients who used solifenacin, which is a bladder antimuscarinic released in 2005 with the prospect of being a more selective antimuscarinic for M3 receptors (M3R), which could make it a safer drug when trying to avoid unwanted effects of older bladder antimuscarinics such as oxybutynin, especially with regard to changes in cognition. Since the various bladder antimuscarinics have distinct pharmacological characteristics, such as in the ability to penetrate the blood-brain barrier, in selectivity for muscarinic receptors, and in brain efflux mechanisms, their effects on the central nervous system (CNS) may vary. Solifenacin was the drug selected in this review, which aims to describe the results of several articles published in recent years reporting the effects of solifenacin on cognition or the risk of dementia development. Although preclinical studies show that solifenacin can also act on brain M1 receptors (M1R), short-term clinical studies have shown it to be safe for cognition. However, there are no long-term randomized studies that prove the safety of this drug for the CNS. Thus, until the safety of solifenacin has been established by long-term studies, it seems advisable to avoid prolonged use of this drug in elderly patients.


Assuntos
Disfunção Cognitiva , Demência , Bexiga Urinária Hiperativa , Idoso , Disfunção Cognitiva/induzido quimicamente , Demência/induzido quimicamente , Humanos , Succinato de Solifenacina/efeitos adversos , Bexiga Urinária , Bexiga Urinária Hiperativa/tratamento farmacológico
19.
Anal Chim Acta ; 1200: 339599, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35256148

RESUMO

Solid contact ion-selective electrodes (ISEs) have witnessed versatile applications in pharmaceutical and biological analysis however they suffer from some limitations. Besides formation of water layer, the doped ion exchanger in sensing membrane fails to distinguish between two ionic species having relatively similar lipophilicity and carrying same charges. Those shortcomings practically hampered the simultaneous determination of alfuzosin and solifenacin in their combined pharmaceutical combination. Hence, this paper was directed to develop two carbon paste electrodes allowing their simultaneous determination based on molecular imprinted polymers (MIPs). Efforts were firstly directed to stabilize the potential signals through synthesis of polyaniline (PANI) nanoparticles with 26 nm particle size as confirmed by means of UV-spectrophotometry, Zeta-sizer and transmission electron microscope. This was followed by its doping at electrode/ion selective membrane interface leading to diminished potential drift, better Nernstian slopes and lower limit of detections. Secondly, MIPs for each drug were prepared by precipitation polymerization technique and fully characterized by Fourier-transform infrared spectroscopy, field-emission scanning electron microscope, differential scanning calorimetry, surface area analysis and rebinding studies. The prepared MIPs were then incorporated in membrane cocktail and doped over PANI layer. The graved cavities inside MIPs act as synthetic host-tailored receptors that could recognize and bind specifically to each drug. The obtained Nernstian slopes were 57.16 mV/decade for alfuzosin MIP-based sensor and 58.17 mV/decade for solifenacin MIP-based one with respective LOD values of 7.9 × 10-7 M and 8.9 × 10-8 M. Moreover, no interference was ostensibly detected from dosage form excipients, plasma constituents or degradation products/official impurities allowing quantification of alfuzosin and solifenacin in their combined capsule, spiked human plasma and in presence of their degradation products.


Assuntos
Impressão Molecular , Compostos de Anilina , Carbono/química , Eletrodos , Humanos , Eletrodos Seletivos de Íons , Polímeros/química , Quinazolinas , Succinato de Solifenacina
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